Nemani Deepika, Vapiwala Neha, Hwang Wei-Ting, Solin Lawrence J
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA.
Int J Radiat Oncol Biol Phys. 2009 Mar 15;73(4):1055-60. doi: 10.1016/j.ijrobp.2008.05.049. Epub 2008 Oct 17.
Little information has been reported regarding outcomes after treatment for patients with early-stage invasive breast cancer and a prior nonbreast malignancy. This report analyzes the outcomes in patients with Stage I and II breast cancer after breast conservation treatment (BCT) with a prior nonbreast malignancy.
The study cohort comprised 66 women with invasive breast cancer and a prior nonbreast malignancy. All patients were treated with breast conservation surgery followed by definitive breast irradiation between 1978 and 2003. Median ages at diagnosis of invasive breast cancer and prior malignancy were 57 and 50 years, respectively. The median interval between the prior malignancy and breast cancer was 7.0 years. Median and mean follow-up times after BCT were 5.3 and 7.0 years.
The 5-year and 10-year overall survival rates were 94% (95% confidence interval [CI], 82-98%) and 78% (95% CI, 59-89%), respectively. There were 4 patients (6%) with local failure and 10 patients (15%) with distant metastases. The 10-year rate of local failure rate was 5% (95% CI, 2-16%) and freedom from distant metastases was 78% (95% CI, 61-88%). No obvious differences in survival or local control were noted compared with the reported results in the literature for patients with invasive breast cancer alone.
Both overall survival and local control at 5 and 10 years were comparable to rates observed in early-stage breast cancer patients without a prior malignancy. Prior nonbreast malignancy is not a contraindication to BCT, if the primary cancer is effectively controlled.
关于早期浸润性乳腺癌且既往有非乳腺癌恶性肿瘤患者的治疗结局,此前报道的信息较少。本报告分析了既往有非乳腺癌恶性肿瘤的Ⅰ期和Ⅱ期乳腺癌患者保乳治疗(BCT)后的结局。
研究队列包括66例浸润性乳腺癌且既往有非乳腺癌恶性肿瘤的女性。所有患者均接受了保乳手术,随后在1978年至2003年间接受了根治性乳腺放疗。浸润性乳腺癌和既往恶性肿瘤诊断时的中位年龄分别为57岁和50岁。既往恶性肿瘤与乳腺癌之间的中位间隔时间为7.0年。BCT后的中位和平均随访时间分别为5.3年和7.0年。
5年和10年总生存率分别为94%(95%置信区间[CI],82 - 98%)和78%(95%CI,59 - 89%)。有4例患者(6%)出现局部复发,10例患者(15%)出现远处转移。10年局部复发率为5%(95%CI,2 - 16%),无远处转移生存率为78%(95%CI,61 - 88%)。与文献中报道的单纯浸润性乳腺癌患者的结果相比,在生存或局部控制方面未观察到明显差异。
5年和10年的总生存率和局部控制率与无既往恶性肿瘤的早期乳腺癌患者所观察到的率相当。如果原发癌得到有效控制,既往非乳腺癌恶性肿瘤并非BCT的禁忌证。